As Member States enter the next stage of drafting and negotiating a new Pandemics Prevention, Preparedness and Response Accord, and the targeted revision of the International Health Regulations (IHR), UNAIDS underscores the importance of protecting the gains made in the AIDS response and encourages Member States to use that experience to help prevent and respond to future pandemics and health emergencies.  

As part of the Sustainable Development Goals and the 2021 UN Political Declaration on HIV/AIDS, world leaders have committed to ending AIDS as a public health threat by 2030. COVID-19 increased HIV vulnerability and disrupted HIV service access for millions of people around the world. The colliding pandemics of HIV and COVID-19 also led to significant setbacks in the TB response. This experience illustrated powerfully how the impact of other pandemics has the potential to halt and reverse gains achieved in the fight against AIDS. 

HIV remains an ongoing pandemic which would be affected by the impact of future pandemics. The actions necessary to make the world safer from future pandemics are vital for ensuring the end of AIDS as a public health threat and for protecting people living with and affected by HIV. Equally, doing what is needed to end AIDS will help keep the world safer from other pandemics.   

At UNAIDS, efforts to support Member States in the pandemic treaty negotiations are rooted in evidence. At UNAIDS, we adhere always and only to facts, science, data and the lived experience of the people in the communities and countries where we work to support and guide the HIV response. We resolutely urge that all who are engaging in the negotiations do the same, standing for evidence, and categorically rejecting any misinformation, mischaracterization, or misattribution. The systematic use of facts and data in the HIV response has built public trust, and hugely contributed to advances in HIV prevention, testing, treatment and care.

Important lessons from the HIV response that can strengthen broader pandemic prevention, preparedness and response include:  

• The infrastructure built up and strengthened to respond to the HIV pandemic – from lab systems, surveillance and health information systems, procurement and supply chain management through to community infrastructure and governance approaches – is vital for addressing other pandemics. For example, this infrastructure was widely deployed and played an essential role in helping countries to respond to the COVID-19 pandemic.

• Enabling equitable and timely access to scientific solutions, health technologies and medical countermeasures to all those in need is critical for saving lives and ending a pandemic. The role of regulation in ensuring the sharing of technology and know-how for generating local capacities in addressing pandemics is key.
• Tackling the inequalities which drive HIV and other pandemics is key to overcoming them. Closing social and economic gaps within and between countries will help the world to avoid the millions of preventable deaths the AIDS pandemic has seen from being repeated in future pandemics.   
• Pandemic prevention, preparedness and response cannot succeed without mobilizing and enabling communities to lead themselves. Investing in community-led mechanisms is critical for successful prevention and response to pandemics.
• Human rights must be at the centre of all actions to prevent and respond to HIV and all other pandemics. The 2021 United Nations Political Declaration on HIV and AIDS, notes the need to “respect, promote, protect, and fulfil all human rights, which are universal, indivisible, interdependent and interrelated.”
• HIV has shown us that beyond being a health issue, a pandemic is a gender, social, economic, security, legal and human rights issue.  Whole-of-government, whole-of-society approaches have driven progress in the HIV response. They should be employed at all levels of governance in pandemic preparedness and response.

The gains made and the lesson learnt in the global response to AIDS can help the world to be better prepared for the pandemics to come.

UNAIDS

The Joint United Nations Programme on HIV/AIDS (UNAIDS) leads and inspires the world to achieve its shared vision of zero new HIV infections, zero discrimination and zero AIDS-related deaths. UNAIDS unites the efforts of 11 UN organizations—UNHCR, UNICEF, WFP, UNDP, UNFPA, UNODC, UN Women, ILO, UNESCO, WHO and the World Bank—and works closely with global and national partners towards ending the AIDS epidemic by 2030 as part of the Sustainable Development Goals. Learn more at unaids.org and connect with us on Facebook, Twitter, Instagram and YouTube.

UNAIDS offers lessons from the AIDS pandemic on the Intergovernmental Negotiating Body Pandemic Accord Bureau text

GENEVA, 24 July 2023—The Joint United Nations Programme on HIV/AIDS (UNAIDS) offers lessons learnt from the HIV/AIDS pandemic to strengthen and sharpen the bureau text of the Pandemic Accord to ensure a truly robust response to current pandemics, and to prevent, prepare for and respond to pandemics of the future.

UNAIDS and the global response to AIDS have unique experience and insight over the past forty years in responding to pandemics. The global AIDS response has shown how effective a pandemic response can be which it outlined recently in its Global AIDS Update 2023 – The Path that Ends AIDS.

While COVID-19 increased HIV vulnerability and disrupted HIV service access for millions of people around the world, the AIDS response, systems, infrastructure and governance model also helped countries respond to both HIV and COVID-19. UNAIDS has a critical interest in protecting the gains in the HIV response, preventing future pandemics and health emergencies which impact people living with and affected by HIV and which could set back efforts to end AIDS by 2030.

Drawing on the more than a quarter-century as a global leader of the fight to end AIDS as a public health threat, UNAIDS offers the following lessons learned for strengthening the current bureau text of the Pandemic Accord:

General language

The current draft could be amended to incorporate much clearer, stronger language on the obligations of high-income countries (HICs) to ensure worldwide access to pandemic products and to proactively provide financial and technical support to enable pandemic responses in low- and middle-income countries (LMICs). The frequent use of “as appropriate” language could be replaced by clear language that conveys the obligation of states to act. In the current draft, much of the burden for prevention and surveillance falls on LMICs, without communicating clear obligations of HICs to assist and support LMICs. It could also have text that commits all countries to prioritise health and medical research.

Human rights and equity

While the draft identifies human rights and equity as core principles of pandemic preparedness, the draft could clarify language regarding the member states’ commitment to protect human rights and ensure equity in all aspects of pandemic prevention, preparedness and response (PPR). The accord could: reconsider the definition of “persons in vulnerable situations” (Art. 1); explicitly reference States obligations to protect and fulfil human rights within its “general principles” (Art. 3.1); mainstream concern for equity throughout provisions of the accord; emphasize formal and substantive equality, alongside non-discrimination, as general principles (Art. 3.1)

Equitable access

With respect to equitable access to pandemic-related products, the bureau draft uses language that suggests that recommended actions are advisory rather than obligatory. UNAIDS recommends that the draft :

• Clearly commit countries that possess pandemic-related medical technologies and knowhow to share it with LMICs in a timely and meaningful manner, including requirements in funding and purchasing agreements for institutions and companies in HICs to share intellectual property rights, technologies and knowhow with researchers and capable manufacturers in LMICs.
• Commit to provide robust financial and technical support for collaborative research between institutions in the North and South to build R&D capacity in LMICs – not only for pandemics and not only for manufacturing, but to enable LMICs to contribute to progress in science and technology for all of humanity.
• Countries to make full use of TRIPS flexibilities to address public health needs during a health emergency.
• Commit all states to waive intellectual property provisions for all pandemic-related products during pandemic and recovery periods.
• Commit Member States to provide political leadership and robust financial and technical support to build strong, flexible medical manufacturing capacity in LMICs before the next pandemic emerges. With future pandemics, surge support will be essential to adapt this capacity in LMICs to manufacture pandemic-relevant products.
• If and when demand for pandemic-relevant products outstrips supply during future pandemics, all Member States must commit to abide by WHO product allocation prioritization recommendations to ensure equitable access, with particular attention to the most vulnerable populations.

Access and benefit sharing

Although the draft specifies obligations among LMICs for actions pertaining to surveillance and the timely sharing of pathogens and data, the draft should be revised to commit Member States to ensure equitable access, including sharing the benefits and profits from the sale of these pathogens. Draw lessons from the Ebola where pathogens from Africa were shared but the medicines were stockpiled in the north leaving people in Africa waiting for charitable donations. The Accord should build on the precedence of the Pandemic Influenza Preparedness agreement (PIP) which facilitates sharing of pathogens and benefits both in terms of vaccines and profit.

Common but differentiated responsibility

While PPR is a shared responsibility of Member States, the draft could make clear that the nature and extent of responsibilities are differentiated based on each country’s financial and technological resources and capacities. As the effects of epidemics are felt most heavily in poor and vulnerable populations, countries that are home to these populations require additional assistance.

Inclusion of community and civil society

Community-led responses play critical roles in reaching marginalized communities with essential health messages and services during a pandemic – as both HIV and COVID-19 have shown – but communities remain under-resourced and inadequately integrated as key partners in national PPR efforts. The Pandemic Accord must acknowledge the central role of community-led responses and commit member states to include communities and civil society in decision-making, planning, preparation, implementation and monitoring.

Sustainable investments in health systems and infrastructure

Sustainable, resilient, well-resourced, equitable, human rights-based and people-centred health systems are essential to PPR and to efforts to achieve Universal Health Coverage. The HIV response has shown clearly how it is possible to leverage HIV investments to build stronger, inclusive, sustainable health and social service systems that respond to both HIV and other health threats. Drawing on previously recommended language on differentiated responsibilities based on national financial and technical capacity, the draft could clearly commit countries to invest major new public financing in health systems – ensuring a well-trained, well-remunerated health workforce (including community health workers); strengthening primary health care; ensuring access to health technologies (including those that are locally produced); and strengthening and effectively using health information systems.

Multisectoral governance

HIV has pioneered inclusive, accountable, participatory health governance across multiple sectors and with community, but there is a risk that PPR governance will be devised as a technocratic, top-down enterprise that does not include the central contributions of communities and civil society. The draft could insist that PPR governance mechanisms be fully inclusive of key stakeholders and integrated at national and regional levels to deal with current pandemics and future health crises. Language on whole-of-government and whole-of-society approaches should be strengthened.

Conclusion

Pandemics continue to exact enormous costs on societies across the world – an estimated 630,000 people died of AIDS-related causes in 2022, and long COVID will has lasting effects on human health and well-being and health infrastructure. In responses to HIV and COVID-19, too many countries and communities have been left to fend for themselves. Responding effectively to current and future pandemics requires the global community to summon the principles of solidarity, equity and people-centred action at the heart of the 2030 Agenda for Sustainable Development. Through learning by doing over decades, the HIV response has shown how it is possible to respond effectively to a pandemic. UNAIDS strongly encourages countries to take on board UNAIDS lessons learned when negotiating revisions to the bureau draft of the Pandemic Accord.

UNAIDS

The Joint United Nations Programme on HIV/AIDS (UNAIDS) leads and inspires the world to achieve its shared vision of zero new HIV infections, zero discrimination and zero AIDS-related deaths. UNAIDS unites the efforts of 11 UN organizations—UNHCR, UNICEF, WFP, UNDP, UNFPA, UNODC, UN Women, ILO, UNESCO, WHO and the World Bank—and works closely with global and national partners towards ending the AIDS epidemic by 2030 as part of the Sustainable Development Goals. Learn more at unaids.org and connect with us on Facebook, Twitter, Instagram and YouTube.

GENEVA, 13 July 2023—A new report released today by UNAIDS shows that there is a clear path that ends AIDS. This path will also help prepare for and tackle future pandemics and advance progress towards achieving the Sustainable Development Goals. The report, ‘The Path that Ends AIDS’, contains data and case studies which highlight that ending AIDS is a political and financial choice, and that the countries and leaders who are already following the path are achieving extraordinary results.

Botswana, Eswatini, Rwanda, the United Republic of Tanzania, and Zimbabwe have already achieved the “95-95-95” targets. That means 95% of the people who are living with HIV knowing their HIV status, 95% of the people who know that they are living with HIV being on lifesaving antiretroviral treatment, and 95% of people who are on treatment being virally suppressed. A further 16 other countries, eight of them in sub-Saharan Africa, the region which accounts for 65% of all people living with HIV, are also close to doing so.

“The end of AIDS is an opportunity for a uniquely powerful legacy for today’s leaders,” said Winnie Byanyima, Executive Director of UNAIDS. “They could be remembered by future generations as those who put a stop to the world’s deadliest pandemic. They could save millions of lives and protect the health of everyone. They could show what leadership can do.”

The report highlights that HIV responses succeed when they are anchored in strong political leadership. This means following the data, science, and evidence; tackling the inequalities holding back progress; enabling communities and civil society organizations in their vital role in the response; and ensuring sufficient and sustainable funding.

Progress has been strongest in the countries and regions that have the most financial investments, such as in eastern and southern Africa where new HIV infections have been reduced by 57% since 2010.

Thanks to support for and investment in ending AIDS among children, 82% of pregnant and breastfeeding women living with HIV globally were accessing antiretroviral treatment in 2022, up from 46% in 2010. This has led to a 58% reduction in new HIV infections among children from 2010 to 2022, the lowest number since the 1980’s.

Progress in the HIV response has been strengthened by ensuring that legal and policy frameworks do not undermine human rights, but enable and protect them. Several countries removed harmful laws in 2022 and 2023, including five (Antigua and Barbuda, the Cook Islands, Barbados, Saint Kitts and Nevis, and Singapore) that have decriminalized same-sex sexual relations.

The number of people on antiretroviral treatment worldwide rose almost fourfold, from 7.7 million in 2010 to 29.8 million in 2022.

However, the report also sets out that ending AIDS will not come automatically. AIDS claimed a life every minute in 2022. Around 9.2 million people still miss out on treatment, including 660 000 children living with HIV.

Women and girls are still disproportionately affected, particularly in sub-Saharan Africa. Globally, 4,000 young women and girls became infected with HIV every week in 2022. Only 42% of districts with HIV incidence over 0.3% in sub-Saharan Africa are currently covered with dedicated HIV prevention programmes for adolescent girls and young women.

Almost one quarter (23%) of new HIV infections were in Asia and the Pacific where new infections are rising alarmingly in some countries. Steep increases in new infections are continuing in eastern Europe and central Asia (a rise of 49% since 2010) and in the Middle East and North Africa (a rise of 61% since 2010). These trends are due primarily to a lack of HIV prevention services for marginalized and key populations and the barriers posed by punitive laws and social discrimination.

Funding for HIV also declined in 2022 from both international and domestic sources, falling back to the same level as in 2013. Funding amounted to US$ 20.8 billion in 2022, far short of the US$ 29.3 billion needed by 2025.

There is an opportunity now to end AIDS by increasing political will by investing in a sustainable response to HIV through financing what matters most: evidence-based HIV prevention and treatment, health systems integration, non- discriminatory laws, gender equality, and empowered community networks.

“We are hopeful, but it is not the relaxed optimism that might come if all was heading as it should be. It is, instead, a hope rooted in seeing the opportunity for success, an opportunity that is dependent on action,” said Ms Byanyima. “The facts and figures shared in this report do not show that as a world we are already on the path, they show that we can be. The way is clear.”

In 2022, an estimated:

• 39.0 million people globally were living with HIV
• 29.8 million people were accessing antiretroviral therapy
• 1.3 million people became newly infected with HIV
• 630 000 people died from AIDS-related illnesses

UNAIDS

The Joint United Nations Programme on HIV/AIDS (UNAIDS) leads and inspires the world to achieve its shared vision of zero new HIV infections, zero discrimination and zero AIDS-related deaths. UNAIDS unites the efforts of 11 UN organizations—UNHCR, UNICEF, WFP, UNDP, UNFPA, UNODC, UN Women, ILO, UNESCO, WHO and the World Bank—and works closely with global and national partners towards ending the AIDS epidemic by 2030 as part of the Sustainable Development Goals. Learn more at unaids.org and connect with us on Facebook, Twitter, Instagram and YouTube.

UNAIDS welcomes the issuance of Resolution 881 of 2023 by the Ministry of Health of Colombia, which initiates the administrative procedure to evaluate the existence of reasons of public interest for issuing a compulsory license for dolutegravir (DTG)-based regimens. According to the ministerial resolution, the impact of this measure could mean a significant reduction of more than 80% of DTG’s price.

Dolutegravir (DTG) is an antiretroviral integrase inhibitor, recommended by the World Health Organization (WHO) as a first-line treatment option for people living with the human immunodeficiency virus (HIV). Regarding viral suppression and disease reduction, treatments incorporating DTG-based regimens have demonstrated greater adherence due to their lower incidence of adverse events while presenting enhanced effectiveness, safety, and reduced likelihood of resistance development.

Compulsory licensing is a provision in the World Trade Organization (WTO) Agreement on Trade Related Aspects of Intellectual Property Rights (“TRIPS Agreement”), that enables governments to supply its citizens with generic versions of patented treatments either through domestic production or imports, ensuring drug prices are affordable. WTO Inter-ministerial 2001 Doha Declaration reaffirmed the rights of member states to make use of all flexibilities in the agreement to protect public health, including compulsory licenses, “and the freedom to determine the grounds upon which such licenses are granted.” More recently, in the 2021 Political Declaration of the United Nations General Assembly High-level Meeting on AIDS, countries have committed to make use of TRIPS flexibilities “specifically geared to promoting access to medicines.”

"This resolution is a step forward to provide equal and sustainable access to best HIV treatment options for all people living with HIV in Colombia, nationals and migrants. This action shows the government’s commitment to close the treatment gap with assured quality affordable essential medicines which are easy to take and very well tolerated.”, says Andrea Boccardi, UNAIDS Director for the Andean Countries (Peru, Ecuador, Bolivia, and Colombia. "The government issued national guidelines in 2021, in line with WHO recommendations, but until now high prices of DTG have remained an obstacle to make it widely accessible to people living with HIV in Colombia."

The Colombian League for the Fight against AIDS and the IFARMA Foundation also celebrated the decision from the Colombian government. Both institutions participated on behalf of civil society in the updating of the Clinical Practice Guidelines (CPG) based on scientific evidence for the care of HIV/AIDS infection in adults, pregnant women and adolescents.

"The decision validates past initiatives of civil society in Colombia to achieve greater coverage of simplified treatments with fewer adverse effects at the lowest possible price, while at the same time it will reinvigorate the efforts of community-based organizations in education and promotion of adherence to ARVs, recognizing that structural barriers are factors that facilitate or hinder adherence to antiretroviral treatments", says Jorge Pacheco, Director of the Colombian League for the Fight against AIDS.

“Through this measure Colombia is taking an important step to guarantee people’s access to the most appropriate medication for them in line with international recommendations and commitments”, says Luisa Cabal, UNAIDS Regional Director for Latin America and the Caribbean. "Timely access to effective HIV treatment can save lives, improve health outcomes, enhance the quality of life, and contribute to the overall well-being of individuals living with HIV. This measure shows commitment to the global effort to combat inequalities in access to health."

UNAIDS commends and supports the Ministry of Health for its proactive approach to pursuing public interest and urges all stakeholders to collaborate in implementing Resolution 881 of 2023. 

UNAIDS

The Joint United Nations Programme on HIV/AIDS (UNAIDS) leads and inspires the world to achieve its shared vision of zero new HIV infections, zero discrimination and zero AIDS-related deaths. UNAIDS unites the efforts of 11 UN organizations—UNHCR, UNICEF, WFP, UNDP, UNFPA, UNODC, UN Women, ILO, UNESCO, WHO and the World Bank—and works closely with global and national partners towards ending the AIDS epidemic by 2030 as part of the Sustainable Development Goals. Learn more at unaids.org and connect with us on Facebook, Twitter, Instagram and YouTube.

A new report by UN Women and CARE International highlights the urgent need to provide health-care services to women in Ukraine and sets out why the international community needs to support a gendered response to Ukraine’s humanitarian crisis.

The report also emphasizes the need for an intersectional approach to the crisis that addresses the exacerbated risks for marginalized communities—lesbian, gay, bisexual, transgender and intersex (LGBTI) people, Roma people, people living with disabilities and people living with chronic diseases—who face immense hardship and have particular needs with regard to their health and safety.

“This powerful report illustrates why and how humanitarian responses need always to be gendered and need also to address the particular needs of marginalized communities,” said Winnie Byanyima, the Executive Director of UNAIDS. “The courage and commitment of women leaders who continue to serve their communities, even in the face of war, in Ukraine and across the world is an inspiration.”

The report’s analysis, which was based on surveys and interviews with people in Ukraine, was conducted in April and details some of the gender dynamics of the crisis and sets out practical and actionable recommendations for the international humanitarian response.

Women and girls interviewed for the report highlighted challenges in access to health-care services, especially for survivors of gender-based violence and pregnant women and new mothers, as well as rising fears of gender-based violence and lack of food, especially for those in conflict areas.

Many respondents referred to the health risks, including the spread of COVID-19, linked to unsanitary shelters.

The war has also impacted access to sexual and reproductive health, including family planning and maternal, newborn and child health. Many media reports have noted that conditions as a result of the war have increased the risk of premature birth.

Transgender people also require regular access to medicines, but many have had to stop hormone therapy due to supply shortages. Several LGBTI organizations are providing access to medicines to members of the transgender community, but their help does not cover all the needs.

“The Rapid Gender Analysis allows us to consult directly with affected populations in order to accurately identify what specific needs different groups of people have, and how to best meet them,” said Sofia Sprechmann Sineiro, the Secretary General of CARE International. “What we are hearing from the people of Ukraine is that certain groups—such as those with disabilities, Roma and other ethnic minorities, single mothers and unaccompanied children—are each in need of different forms of protection and assistance. To keep our response effective and relevant, such groups must be consulted and prioritized across the aid ecosystem as this truly devastating situation continues to evolve.”

The report calls for support for women-led and women’s rights organizations that provide financial resources and for their voices to be amplified at national and international platforms.

Gaps in services to respond to gender-based violence need to be filled, according to the report, while sexual and reproductive health, including the clinical care of survivors of sexual assault, and maternal, newborn and child health care, including access to contraception, should be made a priority.

“It’s critical that the humanitarian response in Ukraine takes into account and addresses the different needs of women and girls, men and boys, including those that are furthest left behind,” said Sima Bahous, the Executive Director of UN Women. “This timely analysis provides the evidence of those needs, and their urgency. Women have been playing vital roles in their communities’ humanitarian response. They must also be meaningfully involved in the planning and decision-making processes to make sure that their specific needs are met, especially those related to health, safety and access to livelihoods.”